| NPI | 1942513916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8336759-4405) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2020-10-12 |